Insurance Claims by cuiliqing

VIEWS: 15 PAGES: 13

									Insurance Claims
Summary
This demo uses an insurance claims example to demonstrate most of the TCM stack,
including: Dispatcher auto-classification, human validation of extracted data, TaskSpace,
BPI, and BAM. It is not intended to accurately represent a real claims process, but show
it can be done and make the demo generic enough for other applications. If you try too
hard to make it real and you show it to a real insurance prospect, you make it hard on
yourself as they shoot down everything you are showing as unrealistic and the demo
becomes too long-winded.

Functional Highlights
   1. I think the summary covers this – most of the TCM stack is demonstrated.

Services That Should Be Started (some of these are started by default)
   1. AppServer – Documentum Webapps (should be automatically started)
   2. AppServer - Tomcat for BAM and ASR applications. Off by default
   3. ContentServer – Content Server/Java Method Server/Docbroker (should be
       automatically started)
   4. ContentServer – You don’t need James Email Server running
   5. ContentServer – You don’t need the Index Agent running
   6. ContentServer – you may want switch off CTS and Full-text indexing related
       services.
   7. Captiva - InputAccel Server and all related services should be running
       automatically when the server is started. You can check by looking for it in
       Services.

Installation
   1. N/A – Installed on the TCM65_v5 image.

Object Locations
Most of the object definition is contained in the claims docapp
/System/Applications/insurance_claims and don’t need to be opened. The main process
Handle Claim is located in the same location. There are also some dummy processes –
these are only for visual affect in the demo and don’t do anything. All of the demo data
is contained in /Claims Manager cabinet: Claims are where the claims folders will be
created, Picklists contains the state/county picklists for the form, Policies contain
insurance policies that match up with the policy holders, Policy Holders contain the
policy holders that contains the data that will be used in the form later, finally Temp is
where Captiva temporarily stores content. All the sample images for this demonstration
are located in C:\DEMOS\ABC_Auto_Claims\Images (Captiva Machine)

Setup For Demo Run
   1. As background, you have 9 potential policy holders with the following SS
       numbers: 111-11-1111 to 999-99-9999. These policy holders have policy
       numbers of 0001 to 0009. For example, SS # of 222-22-2222 will have a policy
       number of 0002. So before the demo, decide which SS # you will fill into the
         form and then be prepared to make sure that is the matching policy number is
         used in the Captiva section (whether simulating Captiva or actually running
         Captiva).
    2.   AppServer Machine - Open PB and open the
         /System/Applications/insurance_claims/Handle Claim process.
    3.   AppServer Machine - Open the Insurance Claims TaskSpace application using the
         IE favorite (the link is under TCM folder). You can log as dmadmin using the
         following roles claim_processor, adjuster, customer_service. You can simply
         switch roles throughout the demo without logging out.
    4.   Client Machine - If you want to use this demo to focus on Captiva, run the
         attached script through step 14 so that it is waiting on the repair estimate to come
         in. That way you can still show a little process because you can show the last task
         in the demo but you don’t have to show all of the preliminary. For those that
         want to go light on the Captiva, there is also a way to simulate Captiva (explained
         in the script).
    5.   AppServer Machine – You may want to uninstall all of the workflows that aren’t
         being used in the demo. You should have: Amend Claim, Apply for New Policy,
         Cancel Policy, Handle Claim, Handle Formal Complaint, Look Up Status of
         Claim, Look up Status of Policy, Possible Fraud Sub-Process, and Receive Repair
         Estimate installed.
    6.   AppServer Machine – You may want to put a shortcut to the Access database
         described in step 31.
    7.   Captiva Machine - you can launch the ScanPlus Module, Dispatcher
         Classification Edit Module, Dispatcher Validation Module. If you need to
         login, use standard Documentum credentials.

Cleanup After Demo
   1. You don’t have to do anything to cleanup after the demo. The demo always
      creates a new case folder with a unique number.


Script
Step What To Do                                                  Business Value or What
                                                                 To Say
1        You are starting out as the customer_service role.      This person’s job is to
         Select Handle Claim and start the process.              answer the phone and start
                                                                 some process based on
                                                                 what the customer
                                                                 requests. That is all this
                                                                 person does, so the user-
                                                                 interface only has this tab
                                                                 available. Explain that we
                                                                 will see how the UI
                                                                 changes based on the role
                                                                 of the person.
2   You have a choice of SS #s to fill in from 111111111      Point out the automatic
    to 999999999 remember this must match the policy          claim number generation.
    number you will or have entered on the repair             We can validate the fields
    estimate that comes later (i.e. 0001 to 0009).            that are required and that
    Purposely leave out the dashes on the SS #. Hit the       the data is in the proper
    Save button (if that doesn’t cause the validation         format. The value is that
    errors to show up, try hitting the submit button next).   making sure the data is
                                                              right the first time saves a
                                                              lot of potential rework
                                                              effort.
3   Fix the SS# so that it has dashes now. Hit the tab        We can also validate
    button so that the rest of the fields are filled in.      against external systems
                                                              and automatically pull
                                                              back info from those
                                                              systems to reduce effort
                                                              and make sure the policy
                                                              holder really exists in the
                                                              system. This is when the
                                                              customer service agent
                                                              can verify who they are
                                                              speaking to.
4   Fill in the state of the incident (doesn’t matter         This shows the dependent
    which). Drop the county field down and show the           picklists because we only
    available counties. Now choose a different state and show the counties that are
    pick a county.                                            valid for a particular state.
5   Choose the loss date as a few days ago. Hit the           There are many different
    submit button.                                            types of controls
                                                              depending on what kind of
                                                              data is required for a field.
6   It will take a minute for the first manual activity to be Point out what the
    reached, so open PB to explain the first part of the      automated steps are doing
    process. Here are some things you can do – but you        and why that is important.
    have to decide based on your audience what level of       For example, retrieving
    detail you want. Point out the automated steps that       the policy for the user
    create the claim folder, set some data on it, and         means an agent doesn’t
    retrieve the customer’s policy number. If you want        have to go find it in case it
    to show one activity, I would open the “Create            is needed for reference.
    Claims Folder” to show how it is parameterized.
7   Before minimizing PB, point out our first manual        Explain the queue
    step: Triage Claim. In TaskSpace, change your role      management value prop.
    to claim_processor. Point out the additional tabs but   Queue management
    say we will come back to them later. While on the       provides true load
    My Claims tab, hit Get Next Task.                       balancing among users
                                                            because a user doesn’t get
                                                            the next task until finished
                                                            with the previous. Queues
                                                            can help meet SLAs by
                                                            having different priority
                                                            escalation depending on
                                                            what is going on in the
                                                            process. For example, a
                                                            platinum customer would
                                                            have a high priority
                                                            escalation than a gold
                                                            customer so the system
                                                            naturally processes that
                                                            group of customers faster.
8   Open the task, and point out how the data on the left   The story is that this
    is shown next to an embedded viewer of the policy.      person just takes a
    This data came from various sources but is all shown    preliminary look to
    on one page. Copy the claim number into the             double-check basic
    clipboard for later use in search.                      information (i.e. is the
                                                            policy actually active
                                                            based on the policy dates
                                                            shown). More
                                                            investigation will take
                                                            place later. This is a task
                                                            specific view and you will
                                                            see additional examples as
                                                            we continue the process.
                                                            The point is to present the
                                                            exact data needed at this
                                                            step of the process. The
                                                            policy was automatically
                                                            retrieved by the process so
                                                            that the end user didn’t
                                                            have to find it. Also, most
                                                            of the fields are read-only
                                                            because this person
                                                            doesn’t have permission to
                                                            change policy data.
                                                            Hammer configuration vs
                                                            customization.
9    Set the Claim Status to Closed – Rejected and then      Point out how the reason
     change it to Awaiting Evidence. (Important: do not      field pops-up when it is
     reject this task). Hit the Finish button.               rejected. The value is that
                                                             any field can be hidden or
                                                             shown depending on the
                                                             data in the form so we can
                                                             guide the user through the
                                                             task. If you forget to set
                                                             the status to Awaiting
                                                             Evidence, don’t worry, it
                                                             will be automatically set
                                                             anyway (just don’t leave it
                                                             as rejected).
10   Now let’s revisit the tabs. Click on Find Claims and The story is that this role
     search for your claim number that you copied into the can search for all claims
     clipboard. If you forgot to do that, search for the     but customer_service
     policy number you chose (remember ###-##-#### of could not. You may need
     the SS maps to 000# policy number). You can show to remind them that we are
     Browse Claims but I don’t think it is very interesting. trying to show a generic
                                                             demo and not trying to
                                                             match reality exactly. The
                                                             point is role-based UI that
                                                             was defined with a
                                                             graphical drag-and-drop
                                                             tool.
11   Switch role to the adjuster. Again, the UI changes.     The adjuster coordinates
     The adjuster did not use a queue so just open the       with the repair shop and
     task. Set who took the picture(s) and the date it was   potentially takes evidence
     taken. You MUST upload at least one photo (but you photos and/or works with
     can add more) in the Upload Photos field. Example       police reports. So this
     photos are in D:\Demos\Claims External Content          particular task has him/her
     Just hit the finish button, you don’t need to hit next. uploading photos from a
     Now hit the Finish button for the task as well.         digital camera. I did not
                                                             use a queue on this step
                                                             just to point out that we
                                                             can automatically assign
                                                             to specific users
                                                             (remember want to make
                                                             it a little generic). Explain
                                                             the value of the digital
                                                             sign-off.
12   Open PB and explain where we are in the process.         We are automatically
     Optionally, you can open the BAM Dashboard using         storing these photos in the
     the IE favorite and show the running instance (login     claim file and setting
     is admin/admin). After done, close the dashboard so      meta-data. Now, the
     you don’t have to worry about refresh problems           process waits for the
     when you show it later.                                  repair estimate to be faxed
                                                              in or scanned via Captiva.
                                                              If you show BAM, explain
                                                              how alerts and instance
                                                              maps help a manager
                                                              know what is going on at
                                                              take corrective action if
                                                              necessary.
13   If you want to show a Captiva demo, skip this step       Even if you aren’t
     and go to the next. To simulate Captiva, use DA to       showing Captiva, explain
     import the repair estimate into /Claims                  the value prop of what we
     Manager/Temp. The file is located at                     are simulating. Captiva
     D:\Demos\Claims External Content\Repair                  scanned or received off
     Estimate.pdf. Make the object type repair_estimate       the fax server the repair
     and fill in the appropriate meta-data. The repair shop   estimate. It classified and
     is ABC Auto Repair Shop and make sure the policy         OCR’ed data from the
     number matches the SS# you used to start the demo        image so that we have the
     (i.e. 111-11-1111 matches policy 0001). It takes 5       proper meta-data to
     seconds or so to get moved out of the Temp folder        associate it to the waiting
     and placed in the proper folder (happens                 process. This is the exact
     automatically).                                          same workflow that
                                                              Captiva starts
                                                              automatically; in this case,
                                                              we just started it manually
                                                              for simulation purposes.
14   Comments                                           In case the question comes
                                                        up: yes the policy number
                                                        is not the best to use for a
                                                        unique identifier to do the
                                                        matching. It should really
                                                        be claim number however
                                                        we wanted to make it easy
                                                        to demo. If we used claim
                                                        number, which is
                                                        automatically generated,
                                                        we couldn’t prep the
                                                        Captiva section with the
                                                        proper claim number
                                                        ahead of time. Claim
                                                        number could, absolutely,
                                                        be the way we match the
                                                        repair estimate to the
                                                        claim – any piece of meta-
                                                        data can be used to do the
                                                        automatic matching.
15   Switch to the Captiva machine. Find the ScanPlus   Level Set – At this point
     module in the windows toolbar among the running    in the big picture, you are
     applications                                       an employee at a repair
                                                        shop and you’ve just
                                                        prepared an estimate to
                                                        repair the damages. You
                                                        need to submit them to the
                                                        Insurance company for
                                                        review.”

                                                        “We’re going to scan the
                                                        documents in this case,
                                                        but this could just as
                                                        easily be the repair shop
                                                        submitting via fax
                                                        machine, Multi-function
                                                        device, e-mail, or even a
                                                        web-browser.” The
                                                        solution supports virtually
                                                        any common “capture
                                                        point” to start this process.
16   Hit New Batch and choose the                          I’m going to import these
     ABC_Auto_Claims_v6 process. Click Create. Select      documents rather than
     the Import button from the Scan module                scan them since I don’t
                                                           physically have a scanner
                                                           attached to this machine,
                                                           but the functionality is
                                                           exactly the same.
                                                           machine, multi-function
                                                           device…
17   The demo documents should automatically be
     available when you select the import button, but if
     they’re not, browse to
     “C:\DEMOS\ABC_Auto_Claims\Images\Demo.”
18   The images come up in the Scan interface. Click       “This is just an arbitrary
     around between the sample images using your           collection of images
     mouse. When your finished speaking, select “Close     designed to demonstrate
     Batch.”                                               our technology’s ability to
                                                           automatically identify,
                                                           separate, and extract
                                                           relevant data from them.
                                                           “
19                                                         “What’s happening behind
                                                           the scenes right now is the
                                                           software is busy trying to
                                                           identify what this
                                                           document is, find the
                                                           relevant content on the
                                                           document and
                                                           automatically extract it.

                                                           Whenever the software is
                                                           not “confident” (based
                                                           upon thresholds you
                                                           configure) that it’s
                                                           identified a page correctly,
                                                           it delivers the documents
                                                           to a “human” interface to
                                                           make sure it’s making the
                                                           correct assumptions.”
20   Switch to Classification Edit window. If the task is    At this point, the software
     not in the queue yet click refresh list. Once you see   has confidently identified
     the task click “run selected”. Remember the policy      the documents in this
     number should match the SS# you entered earlier so      sample set, but it wouldn’t
     you can manually change it here if necessary.           make a very impressive
                                                             demonstration if it just
                                                             “showed-up” in the BPM
                                                             so for purposes of this
                                                             demo, we simply need to
                                                             confirm the document
                                                             type.

                                                             You also notice that in this
                                                             case, the software also
                                                             confirms the Policy
                                                             number at this stage of the
                                                             process.
21   While on the Policy Number verification, hit enter.     Once the documents are
     If that doesn’t work, try CTRL-Enter.                   classified, we move them
                                                             into our recognition
                                                             engine to extract the
                                                             relevant content from the
                                                             document.

                                                             For this demonstration,
                                                             we’re extracting a handful
                                                             of fields, but this could
                                                             potentially be dozens of
                                                             fields that we’re extracting
                                                             and validating. Including
                                                             verification of information
                                                             against a database, field
                                                             calculations.
22   Switch to Validation interface. Again if the task is     Once again, the software
     not in the list you should click refresh list and then   has very confidently
     “run selected”. You may want to change the amount        identified the content to
     if you are running this several times and want a good    extract from this
     sample of data for BAM.                                  document set. We’ve
                                                              configured the interface to
                                                              confirm the data in a
                                                              human interface.

                                                              Remember that the overall
                                                              goal here is to eliminate
                                                              this human validation
                                                              altogether. Consider even
                                                              low confidence scenarios,
                                                              say 60% failure, we’re
                                                              still talking about 40%
                                                              less “human” data entry
                                                              work than what is being
                                                              performed, today for
                                                              example. Those are the
                                                              kind of raw ROI numbers
                                                              that can really add-up as
                                                              your volumes increase.
23                                                            Other options on the page,
                                                              will allow you to
                                                              demonstrate Rubber-band
                                                              OCR. Field level “auto-
                                                              zoom” and other standard
                                                              Dispatcher functions.
24   Ctrl – Enter to confirm the data entry elements   Once you have validated
                                                       the data, we move it into
                                                       the business process and
                                                       automatically transfer the
                                                       images and
                                                       metadata/data/content
                                                       directly into a specific
                                                       business process
                                                       associated with this policy
                                                       and/or claim number.

                                                       Remember, finally that
                                                       what we you just saw is
                                                       really the exception
                                                       handling process. The
                                                       overall goal here is that
                                                       100% of these documents
                                                       never see a human being
                                                       at all, but rather move
                                                       directly back into the
                                                       business process.

                                                       Considering most paper-
                                                       based processes in use
                                                       today, where someone
                                                       walks to the fax machine
                                                       sorts these documents and
                                                       physically moves them
                                                       around the business to
                                                       start a physical capture
                                                       process, we’re talking
                                                       about a fundamental and
                                                       very tangible shift in the
                                                       performance of what was
                                                       previously a 100%
                                                       human-based,
                                                       cumbersome process.

                                                       Now these documents are
                                                       already electronic, your
                                                       knowledge workers can be
                                                       working from home, via
                                                       the web, or on the other
                                                       side of the world to
                                                       support virtually any
                                                       business model you can
                                                       conceive.
25   Switch back to AppServer machine. Open                  Point out a new UI that
     TaskSpace as the claims_processor role. Click on        was made for this specific
     My Claims and hit Get Next Task; open the task.         role. This role is doing
                                                             the final review and
                                                             double-checking the data.
                                                             Notice that we have the
                                                             repair estimate associated
                                                             to the process now as well
                                                             as the claims folder itself.
                                                             Note: if the amount did
                                                             not get filled in correctly,
                                                             you may have to type it in
                                                             and hope the question
                                                             doesn’t come up. Or you
                                                             can just blow right past it.
26   Open the claims folder by right-clicking on it and      Point out that the claims
     choose open.                                            folder is where some of
                                                             the data we have seen
                                                             before is actually stored.
                                                             Also, the claims folder
                                                             contains all of the
                                                             important documents
                                                             pertinent to this case.
27   Right-click on repair estimate, after explaining, hit   We can see the repair
     the cancel button.                                      estimate next to the data
28   Optionally, right-click on one of the evidence photos   We can see the picture
     and choose open. After explaining, hit cancel.          along with the data that
                                                             was assigned earlier in the
                                                             process by the adjuster.
29   Close the folder browser by hitting the x on the        If you forget to set the
     thread bar above. Set the status to Closed (don’t set   status, don’t worry – I
     Closed – Rejected). Hit the Finish button to finish     automatically set it
     the task.                                               anyway (just make sure it
                                                             is not Closed – Rejected).
30   Open PB. Explain that the claim has been closed and    Much of the master data
     one of the things the process does is send the         actually resides in external
     important data to the Claims System. If this is a      systems for this process.
     technical audience, double-click the Write To Claims   It is important to be able
     task and show the data mapping.                        to use standards-based
                                                            integration to write and
                                                            read to/from various
                                                            systems. In this case, we
                                                            are just using a simple
                                                            database because we, of
                                                            course, don’t have a real
                                                            claims system; however
                                                            the concepts are the same
                                                            regardless of protocol. If
                                                            you show the data mapper,
                                                            this should hopefully hit
                                                            home that we are a real
                                                            BPM suite and not just a
                                                            document workflow
                                                            system.
31   Open Microsoft Access and open the                     Show that the recent run is
     Z:\Access\Claims System.accdb database (listed in      at the bottom of the table.
     recent database on the right). You could also prep
     the system by having a shortcut on the desktop.
     Double-click the Claims table.
32   Switch to Analysis tab in taskspace. This tab is       This tab represent
     available for claim_processor role.                    insurance reports. All of
                                                            them are pretty self-
                                                            descriptive. Note that you
                                                            may drilldown into
                                                            Number of Claims by
                                                            State report and it will
                                                            open a dependant report
                                                            Claims by Policy Type.
                                                            Please note that these
                                                            reports are filled with the
                                                            demo data and do not
                                                            reflect the changes from
                                                            your demo process/
33                                                          Summarize what you have
                                                            shown and reemphasize
                                                            the value points you have
                                                            made along the way.

								
To top